Florida's Va System Falls Victim To Its Own Success

The Agency Says Enrollment Is Soaring Because Benefits Are Better And Cheaper Than Elsewhere.

April 16, 2005|By Erin Cox, Sentinel Staff Writer

THE VILLAGES -- Navy veteran James Lowe's teeth are turning brittle as he approaches 77. His wife worries about his heart.

The couple live on $1,785 a month from Social Security and cover their health care with Medicare, spending a couple hundred dollars a month for supplemental insurance and medication. When a Department of Veterans Affairs clinic opened here this month, Lowe enrolled in low-cost VA care, joining the more than 467,000 vets who are stretching Florida's VA system to its seams.

"I figured, well, if it don't cost nothing, I'll go on over there," said Lowe, who needs to get his teeth checked and to make sure his heart is all right 17 years after quadruple-bypass surgery.

Struggling to meet the demand of aging veterans, the state's VA system has seen outpatient visits soar from 1.7 million to 4.1 million from 1996 to 2003, a 141 percent increase. Within two years, officials expect that number to increase by an additional 19 percent.

Lowe's two-year service, which required him to feed intelligence films into a movie reel in Panama after World War II, earned him VA benefits that drop his cost for heart medication from $36 a month under Medicare to $7 a month with the VA.

"They've drawn people who are able to get care elsewhere because they are getting better care at the VA," said Sherry Glied, head of the Department of Health Policy and Management at Columbia University's Joseph L. Mailman School of Public Health.

To try to keep up with demand, the VA has been opening clinics across Florida as quickly as it can -- six in the past six years, VA spokesman John Pickens said. That includes the one in The Villages, the sprawling retirement community that spans three counties. It opened with a six-month waiting list for veterans who wish to transfer their care.

"What we have seen is an increase in people who want to take advantage of the quality of the VA health care, the access of the VA clinics in their community and, among other things, the pharmacy," Pickens said. "Demand has exceeded capacity."

Veterans in Florida strain the system disproportionately compared with the rest of the country. And even though the number of Central Florida veterans has declined by 17,000 during the past five years, more of those who are eligible are clamoring for benefits they would not have touched a decade ago, experts said.

"Veterans who used to just avoid the VA are happy to go there because they are getting better care," said Glied, explaining the jump in outpatient visits. "It's the penalty of success."

The National Committee for Quality Assurance, which examines and ranks health plans, praised the VA in its 2003 annual report.

"It is a little-appreciated fact that Americans who receive care through the VA -- a system that has ballooned in enrollment while shedding staff over the past decade -- generally get better care than the rest of us," the report said. "But across dozens of measures of performance, the data are quite clear: the VA delivers top-notch care."

The boom in outpatient visits is partly a result of a transition from hospital stays to outpatient care, a trend throughout the health-care industry.

But in Central Florida, VA hospitals are poised for expansion, too. During the next decade, the Gainesville hospital will add a bed tower, and the Tampa hospital will install a spinal clinic. In Orlando, construction on a new 120-bed hospital is expected to begin in 2006 -- the culmination of a long struggle to bring a hospital to the nation's largest metropolitan region without a VA inpatient facility.

The seemingly never-ending influx into the VA system is an issue of access.

When Lowe moved to The Villages from Tennessee four years ago, he went to the local VA chapter hoping to receive VA benefits.

Besides, he would have to drive an hour to Gainesville for care. His wife, Betty, 68, said, "He thought it was too far; he thought it was unnecessary." But as access to neighborhood clinics such as the one serving The Villages increases, VA care becomes the best option available to veterans who never signed up before.

"The medicine is killing us," said Betty Lowe, who has suffered two strokes. "Sooner or later, something's going to go wrong."

Now that a clinic has opened nearby, VA care is a convenient and cheaper alternative for her husband.

Officials expect more veterans such as Lowe, and aging baby boomers behind him, to flood the system. And the VA is bracing for the next wave of enrollees: younger Iraq war veterans who will be discharged within the next few years, Pickens said.